Background:

The main function of obturation is to fill the whole canal with an inert
root canal filling material into space and eliminate all portals of entry between
the periodontium and the root canal system. Ingle et al. reported that 58% of
endodontic treatment failures can be associated, to incomplete obturation of
entire root canals. To overcome all these drawbacks, the most recent
advancement in endodontic obturating materials uses a hydrophilic polymer in
the root canal. The C‐Point system (Endo Technologies, LLC, Shrewsbury,
MA, USA) consists of obturation points (C‐points) containing a polyamide core
with an outer bonded hydrophilic polymer coating.

Thus, newly introduced root canal obturating system SmartSeal is

established on the polymeric technology. The hydrophilic nature of the
obturating points can absorb surrounding moisture and expand, resulting in
filling of voids and spaces, onto which the principle of this system depends.
Ever since its introduction, Smartseal has been extensively stated to be
efficaciously used in endodontic treatment. This review article goals to deliver
an ephemeral synopsis of this obturating system with a reference of the studies
associated with it.
The polymer technology of CPoint is manipulated in a such a manner by
the manufacturers that the obturation point shows controlled expansion by only
radial expansion rather than axial direction which helps in swelling up of
material only laterally. The anisotropic expansion of the material stops, once
resistance is felt, thus preventing the fracture of root, that would possibly be
generated during lateral expansion. Although the C‐point is efficient in
achieving a relatively good fit in an irregular‐shaped root canal, a concomitant
sealer has to be used for complete sealing of the gaps which are present between
the root canal walls and the expanded C‐point. Lateral expansion of C‐points,
occur nonuniformly, and the expandability of points depends on the extent to
which the hydrophilic polymer is prestressed.This determines the amount of
expansion.

Introduction:
Obturation of root canal system is the most important step in successful root
canal treatment. It is defined as “the three dimensional filling of the entire root
canal system as close to the cementodentinal junction as possible” 1. In recent
years, there has been an increased concern over the poor sealing properties of
the conventional root-filling materials, gutta-percha and the different sealers.
Studies have demonstrated microleakage in canals filled with these materials
leading to ingress and propagation of bacteria resulting in infection. Proper seal
at the coronal, middle and the apical end of a root canal is achieved only if the
material has the ability to seal the root canal dentin in all directions2.

The introduction of newer root canal filling materials ensures better adhesion to
root canal dentine.C-Point is a novel obturating material that is said to exhibit
non- isotropic lateral expansion to enhance the sealing ability of the material.
Ever since its introduction, Smartseal has been extensively stated to be
efficaciously used in endodontic treatment.

Cpoints:

Smartseal is a two-part system comprising of: Propoint and Smartpaste /

Smartpaste Bio. Propoint, best known as the ‘C points’, these obturation points
are fabricated in two parts: Central Core and the Outer Layer. The central core:
comprises of a blend of two branded nylon polymers, Trogamid T and
Trogamid CX. It is well-thought to deliver the point with the elasticity, allowing
it to effortlessly permit around any curvatures in the biomechanically prepared
canal, while being inflexible sufficient to pass effortlessly to the length in
slender canals. The Outer Polymer Layer: comprises of a cross-linked
copolymer of acrylonitrile and vinyl pyrrolidone that has been cross-linked
using allyl-methacrylate and a thermal initiator. This layer is hydrophilic,
having a hydrogel coating, that allows swelling up of the points to acclimatize
the corollaries of the root canal system. This covering is planned to swell
sideways, thus self-sealing the root canal. As there is no axial swelling, no
length change is present and radiated swelling halts as soon as a seal is formed.3

Principle:
The hydrophilic nature of the obturating points can absorb surrounding moisture
and expand, resulting in filling of voids and spaces, onto which the principle of
this system depends.

Controlledexpansion
Mechanism:
Propoints reveals the hydrophilic
nature, permitting infinite simal
volume of water existing in the root
canal system and the naturally present
moisture in the dentinal tubules that is
engrossed by these points. This water
may hydrogen bond to the existing
polar locations, permitting the
enlargement inside the polymeric
chains. The proportion and range of
such expansion is well-ordered as part of the manufacturing course. This
expansion befalls with a diminutive force that is appealed to be less than the
testified tensile stress of dentine and a segment of the strength engendered while
using the conventional methods such as warm vertical compaction. Such a type
of expansion ensues in the first 4 hours after employing the point into the root
canal and permitting the gentle adaptation of point to whichever peccadilloes
present in the root canal system. This results in the polymer and sealer being
conveyed into the dentinal tubules. The trivial positive pressure against the root
canal wall that is fashioned, forms a hallmark that is supposed to be effectively
impervious to the microbial microleakage. Shweta Tekriwal et al [2017] found
that there is a considerable amount of expansion after four hours of obturation
due to the swellable nature of the sealer and the ProPoint. Volumetric expansion
of 13- 27 % approximately was observed4.

Smart seal obturation:

One propoint shields all tip sizes and it is obtainable in the following sizes:

 6% taper - ISO tip sizes 25 to 45

 4% taper - ISO tip sizes 25 to 45
 ProTaper™ - F1, F2, F3, F4 & F5
 Sendoline™ S5 - S2, S3, S4.
The Smartpaste:

Smartpaste is a resin based sealer comprising of an active polymer that swells to

fill any spaces or openings in the root canal system. The extent of the active
polymer used well-orders the degree of pompousness. There can be swelling of
the polymer at a future date for filling any cavities that may progress. It is
dispensed in a syringe to ensure an accurate ratio of sealer components is
achieved every time and mixing/dispensing trays are provided to aid
application.
Smartpaste Bio:

It is a resin based sealant intended to swell up, by the addition of ground

polymer. The manufacturer asserts that the adding of bioceramics, gives the
sealer an extraordinary dimensional immovability, thus making it a non-
resorbable inside the canal of the root. There is production of calcium hydroxide
and hydroxyapatite as a byproduct during the setting reaction of the bio-paste,
interpreting the material both anti-bacterial while setting and very
biocompatible once set. Also, it has a delayed setting time (4 to 10 hours), and
is hydrophilic in nature, allowing the propoint to hydrate and well to fill any
voids. The sealant is delivered in a pre-mixed syringe and does not require
mixing as it can be applied directly into the canal using an intra-canal tip
minimising wastage of material. The cement absorbs water from within the
canal and once set smartpaste bio produces a radiopaque biocompatible
cement5.

Accessories:

Smart-trim: Comprises of a kit consisting of 2 long flame gold burs and 2

pear diamond burs, for trimming the superfluous amount of propoints.
Directions of use:

Flame bur should be used on a high-speed for removing the additional and then
forcing down on the top with the pear bur until the propoint is flush with the
orifice. As the Smart paste is hydrophilic, water can be kept on it when used.

If using smartpaste bio, burs must be kept dehydrated or else the water may
wash away much of the sealer.

Smartgauge:

It is a measuring block designed to slender the 4% and 6% taper propoints to the

apical wanted size. It diminishes the necessity to transmit large stocks of pre-
trimmed points and thus allowing a custom fit.

Directions of use:

The manufacturer has acclaims the trimming to one size small to that which is
being prepared, i.e. if a size 40 has been prepared, then the propoint can be
sheared to a size 35. Trimming is done by stridenting the point through the
equivalent hole in the smart-gauge and then shearing off the additional with a
scalpel. The points are stiff enough to be gnawed at the root canal apex, a snug
fit is sensed with positive tug back at the accurate working length. The
smartgauge is autoclavable at the traditional settings
Canal Irrigation:

Prosmart points are compatible with all of the common irrigation techniques.
As with all root treatment techniques, copious irrigation is essential; however,
excess irrigant should be removed with paper points.

Canal Obturation:

1) Simply choose the Propoint that matches the size of the final file used to
complete the canal.

2) Try in a matching Propoint to ensure it reaches full working length and you
have tug-back. If the point does not go to length then either use the final file
again to ensure adequate shape or use a smaller size Propoint.

3) Take a radiograph to confirm the position of the point.

4) Place the sealer into the canal. The sealer can be introduced into the coronal
two-thirds of the canal using the provided syringe tips.

5) The Propoint is introduced into the canal to the working length using
tweezers.

6) The Propoint can be trimmed to the level of the canal orifice using a high-
speed handpiece and a diamond bur. This is available in the SmartTrim
trimming Kit.

Advantages of C points:

C Point obturation system (EndoTechnologies, Shrewsbury, USA), also

known as Propoint which is a part of the Smartseal obturation system , is a
novel single- cone hydrophilic system, according to the manufacturer, which
provides a three- dimensional seal as it had greater efficiency in filling
simulated lateral canals and a comparable homogeneity of obturation . Anthony
Didato et al [2013] suggested that when exposed to water, the lateral expansion
of a new hydrophilic endodontic obturation point significantly increases in
dimension within 20 min, whereas a conventional gutta-percha point does not6.
C Point cones contain a central polyamide core to provide good handling

The single-cone CPoint system resist bacterial leakage compared to that of

laterally condensed gutta percha with different sealers because of post-setting
expansion showing an approximately 14% expansion after 20 minutes which
could provide better sealing and adhesive properties, as it decreases the gaps
and voids found between the main cone and the root canal walls. Tapati
Manohar Sinhal et al [2018] suggested that all the obturating technique showed
some degree of microleakage. Root canals filled with C‐point system showed
least microleakage followed by thermoplasticized obturating technique with no
significant difference among them. C‐point obturation system could be an
alternative to the cold lateral condensation technique.

The use of bioceramic sealer with CPoint cones provided better sealing ability
due to the slow setting time of bioceramic sealer which provides more time for
the expansion of the CPoints,pushing the sealer towards dentinal walls so better
filling of the canals irregularities. Mobarak A et al [2015] stated that CPoint
with endosequence bioceramic sealer provided the best coronal seal while MTA
Fillapex was the worst. CPoint obturation system can be an alternative to lateral
condensation technique7.

CPoint cones with BC sealer showed better sealing ability than laterally
condensed gutta percha with resin sealer. Moreover, BC Sealer’s extremely
small particle size (2 μm) and hydrophilic nature allow it to flow into all aspects
of the canal anatomy.

Geometry of point can be accurately made

Controlled expansion

Biocompatibility
Release of calcium and hydroxyl ions from the calcium silicate-containing
material results in the formation of an apatite layer. Formation of this interfacial
layer develops a chemical bond between calcium silicate-based materials and
dentinal walls decreasing the marginal leakage and gaps

Disadvantages of Gutta percha:

 Lack of rigidity
 Lack of length control
 Easily displaced by pressure
 Lacks adhesive quality
 Procedure sensitivity
 Microleakage

For overcoming and improving such problems and for enhancing the
consequences of the treatment, an advanced root canal obturating system called
Smartseal TM was established.

In a study, done by Aswathy

Prasad et al [2018] - A
comparative evaluation of
retrievability of Guttapercha ,
Resilon and C Points for
retreatment, using two different
rotary retrieval systems - An ex
vivo study, It was stated that
almost 75%–100% of Smart‐
Seal obturating remnants were
retained in the middle and
apical parts of the RCS .This
can be attributed to the fact that C point showed an approximately 14% of
expansion after 20 mins and enhanced biocompatibility with the root dentin.
Furthermore, the addition of bioceramics to the resin‐based Smartpaste Bio
sealer produces a calcium silicate hydrate gel and calcium hydroxide when
hydrated, giving it exceptional dimensional stability, biocompatibility, and
nonresorbable ability inside the root canal8. Therefore, the property of
expansion in conjunction with the bioceramic nanoparticles led to a greater
penetration of the polymer and sealer into the dentinal tubules, especially due to
the greater diameter of dentinal tubules present in the middle and apical thirds
of the RCS as seen in the SEM images.

Microleakage is one of the most crucial causes of endodontic failure and is

defined as the passage of bacteria, fluids, and chemical substances between the
root structure and filling material. Microleakage in endodontics is multi-
factorial, as it may depends on several factors as root filling technique, root
filling material, type of sealer used and bonding to root canal walls. So sealing
all the communication pathways between the coronal and apical portions of the
root canal system is necessary for the long-term success of the root canal
therapy. The main advantage of the C Point system, according to the
manufacturer, is its lateral expansion which occurs until it becomes pre stressed
by the contact with the canal walls. But this exclusive property may be lost if it
was used in conjugation with the lateral condensation technique. Thus single
cone-C points are superior than Gutta percha used with different sealers.

Conclusion:

The selection of appropriate obturating material is crucial in successful

endodontic therapy. Proper root canal filling technique alongwith obturating
material and sealer will ensure a complete seal of the root canal. Currently,
Gutta-percha with a unique property of inertness, better sealing ability and the
ability to do retreatment in case of failure, makes is an indispensible obturating
material. Recent advances in alternative root filling materials also promises
better adhesion to root canal and avert the short comings of gutta-percha.
CPoint with endosequencebioceramic sealer provided the best coronal seal by
reducing the speed of bacterial penetration through the root canal filling. Thus
single-cone obturation with well-fitted CPoint cones and bioceramic sealer is an
alternative for traditional lateral compaction technique.
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